Guests

Dr. Deborah Schrag:Chief physician in the Population Sciences Department of the Dana-Farber Cancer Institute

In 2012, a new drug for treating colon cancer — Zaltrap — was approved by the Food and Drug Administration, and hospitals across the country started prescribing it to patients. But in an unprecedented move, one of the country's most prestigious cancer care centers, Memorial Sloan-Ketterling, refused to stock the drug.

The reason? The drug was expected to cost nearly $11,000 a month, and only extend life for about a month and a half.

We talked with some of the physicians who are trying to battle the rising cost of treatment. Some highlights:

Dr. Deborah Schrag: Hardest on the middle class
People who are affluent pay this [for example, $9,000 a month to control a brain tumor]. People who are publicly insured through the Medicaid program or have a Medicare insurance policy with supplemental coverage ... they're somewhat immunized from these costs because they have coverage. It's folks who are middle class, and working, and depending on a paycheck, who really have the hardest time coping here. ...

It's really hard when people are sick and at the end of their lives. Particularly because four weeks [added survival time] is an average. When someone is pregnant and walks into their obstetrician's office, the obstetrician can say, 'You're going to be pregnant for about nine months.' Doctors sometimes are very good at giving estimates. But in cancer medicine, we're not good at giving cancer estimates. We can give averages ... there's lots of individual variation. And we want to be hopeful. ... No one wants to start out by talking about the costs. So it's often relegated to sort of a secondary issue, which has major downstream consequences.

Dr. Leonard Saltz: 12 days with diarrhea and a rash? No, thanks
There are two ways you can look at it. There's a drug called Tarceva that is FDA approved for pancreas cancer on the basis of a randomized study that showed a median survival benefit of 12 days. Now, yes, everybody hopes to be on the far end of the curve. Everybody wants to win the lottery and be that one person that does remarkably well, or those few people that seem to do remarkably well, but of course that's a low-probability shot. So if I say to patients simply, 'There's a drug that's FDA-approved that we can add to your treatment, that has been shown to significantly improve survival,' of course everybody says, 'Do it.' Now, if I say, 'There's a drug that's been shown to statistically significantly improve survival by a median of 12 days, and it causes diarrhea and a skin rash as part of its side effect, costs about $8,000 a month of which insurance is likely to pay most, are you interested?' Most people are not. So it's really a matter of looking at the total picture and not sugar-coating it. ... It's a balance. The more you give people the full story, the more they can make intelligent choices.

Saltz: In an open market, nobody would be buying
If you look at the drug-approval process ... the FDA is mandated by law not to consider price in determining whether a drug is going to be approved or not. You've then got the Medicare Modernization Act, which covers medications and requires that the government is not able to negotiate price. ... So the largest buyer is going to basically have to pay any price that the pharmaceutical company sets. There's no room for discussion on that. This really doesn't let any kind of market force take place, and the drug is being paid for, for the most part, by a third party, so that there are enough people out there that can afford a drug at $70,000 to $80,000 a year. If you simply priced an item at that level, virtually nobody could buy it. There'd be no sales, and market forces would bring the price down. But you have situations now where all of us who want the drug have some way of getting it paid for - at least, enough of us that the system can support these prices. And that's going to be a self-perpetuating problem until and unless the legislation changes or the money runs out.

LEARN MORE ABOUT THE COST OF NEW CANCER DRUGS:

• In Cancer Care, Cost Matters
In most industries something that offers no advantage over its competitors and yet sells for twice the price would never even get on the market. But that is not how things work for drugs. The Food and Drug Administration approves drugs if they are shown to be "safe and effective." It does not consider what the relative costs might be once the new medicine is marketed. (Peter B. Bach, Leonard B. Saltz and Robert E. Wittes, in an op-ed in the New York Times)

•
High Cost Of New Cancer Drugs Sparks New Care Struggle
But an economic drama that neither side wants to confront is playing itself out in cancer wards and oncologists' offices across the country. Unaffordable new drugs, even when they're covered by insurance, are being rationed by price as patients, doctors and hospital officials struggle with what is likely to be the most pressing problem for the nation's health care system over the next decade: how to pay for the spectacular rise in the cost of cancer care, especially drugs and diagnostic tests. (The Fiscal Times and Kaiser Health News)